The NHS White Paper 2010

A system not structure Outcomes focused Robust Quality & Economic regulation Empowered professionals in autonomous providers Informed Patients choice Enhanced local voice GP Commissioning PBR

Equity and Excellence Key Provisions Putting patients first - Shared decision-making, choice, increased personalisation, collective voice of patient Improving healthcare outcomes - abolish targets in favour of outcome measures, quality standards to inform commissioning, money following patient, providers paid according to performance Autonomy, accountability and democratic legitimacy - devolve commisssioning to GPs, set up NHS Commissioning Board, promote of staff-led social enterprise, CQC strengthened as inspectorate, ring-fence public health budget Cutting Bureaucracy and improving efficiency - £20bn effiency savings to be re-invested to support outcomes, 45% reduction in management costs, reduce number of DH/NHS organisations

Partnership Licensing Department of Health NHS Commissioning Board GP Commissioning Consortia Providers Monitor CQC Patients & Public Local Authorities Local Authorities Local HealthWatc h Local HealthWatc h Accountability Funding contracts

NHS Commissioning Board Accountable to the Secretary of State, paving the way for the abolition of SHAs. Will develop the NHS Outcomes Framework: –A comprehensive set of indicators, reflecting the quality standards developed by NICE Will commission dentistry, community pharmacy and primary ophthalmic services and maternity Will commission national and regional specialised services, influenced by GP consortia Will calculate practice-level budgets and allocate these directly to consortia. Will be responsible for holding consortia to account for stewardship of NHS resources and for the outcomes they achieve as commissioners There will be a duty to establish a comprehensive system of GP consortia

Public Health The current performance regime will be replaced with separate frameworks for outcomes that set direction for the NHS, for public health and social care, which provide for clear and unambiguous accountability, and enable better joint working. The Secretary of State, through the Public Health Service, will set local authorities national objectives for improving population health outcomes. Local authorities will determine how best to secure those objectives, including by commissioning services from providers of NHS care.

Local authorities’ responsibilities Promoting integration and partnership working between the NHS, social care, public health and other local services and strategies Leading joint strategic needs assessments, and promoting collaboration on local commissioning plans, including by supporting joint commissioning arrangements where each party so wishes Building partnership for service changes and priorities. As well as elected members of the local authority, all relevant NHS commissioners will be involved in carrying out these functions, as will the Directors of Public Health, adult social services, and children's services. They will all be under duties of partnership. Local HealthWatch ensure feedback from service users is reflected in commissioning plans.

Directors of Public Health Local Directors of Public Health will be responsible for health improvement funds allocated according to relative population health need. The allocation formula for those funds will include a new “health premium” designed to promote action to improve population-wide health and reduce health inequalities. Director of Public Health will be jointly appointed with the LA and the Public Health Service PCT responsibilities for local health improvement will transfer to local authorities

GP commissioning consortia GP commissioning on a statutory basis, with powers and duties set out in primary and secondary legislation. Every GP practice will be a member of a consortium No size indicated – likely to be minimum population of 100 – 150k so – consortia Consortia of GP practices, working with other health and care professionals, and in partnership with local communities and local authorities, will commission the great majority of NHS services for their patients. Each consortium will hold its constituent practices to account against these objectives. They will not be directly responsible for commissioning services that GPs themselves provide, but they will become increasingly influential in driving up the quality of general practice. Will be overseen by NHS Commissioning Board

Providers All NHS Provider Trusts to become Foundation Trusts Strong pressure to use social enterprise models ‘Any willing provider’ concept

Regulation Promote competition Set maximum prices Maintain continuity of care Monitor Quality Safety CQC Any Willing Provider Foundation Trusts Private Sector 3 rd Sector Primary Care

HealthWatch England A new independent consumer champion within the Care Quality Commission. Local Involvement Networks (LINks) will become the local HealthWatch Local authorities are to fund local HealthWatch groups. Enhance the role of local authorities in promoting choice and complaints advocacy, through the HealthWatch arrangements they commission.

When will this happen? In 2010/11: GP consortia to begin to come together in shadow form (building on practice based commissioning consortia, where they wish). In 2011/12: a comprehensive system of shadow GP consortia in place and the NHS Commissioning Board to be established in shadow form. In 2012/13: formal establishment of GP consortia, together with indicative allocations and responsibility to prepare commissioning plans, and the NHS Commissioning Board to be established as an independent statutory body. In 2013/14: GP consortia to be fully operational, with real budgets and holding contracts with providers.

Implications for disabled children Discussion today Council for Disabled Children – briefing paper with commentary and questions for consideration Response to consultation on proposals by 11 October 2010

NHS Alliance Conference Slide here

References Department of Health (2010a) Equity and Excellence: Liberating the NHS. Cm7881. Department of Health (2010b) Transparency in Outcomes – A framework for the NHS. Department of Health (2010c) Liberating the NHS: Increasing democratic legitimacy in health. Department of Health (2010d) Liberating the NHS: Commissioning for patients – consultation on proposals. Department of Health (2010e) Liberating the NHS: Regulating healthcare providers. Department of Health (2010f) Liberating the NHS: Report of the arms-length bodies review.